This WebM&M describes two incidences of the incorrect patient being transported from the Emergency Department (ED) to other parts of the hospital for tests or procedures. In one case, the wrong patient was identified before undergoing an unnecessary procedure; in the second case, the wrong patient received an unnecessary chest x-ray. The commentary highlights the consequences of patient transport errors and strategies to enhance the safety of patient transport and prevent transport-related errors.
Studies show that home visits to patients recently discharged from the hospital can help prevent unnecessary readmission.1 Providing continuing care instructions to patients in their homes—where they may be less overwhelmed than in the hospital—may also be a key mechanism for preventing readmission.2 Home visit clinicians and technicians can note any health concerns in the home environment and help patients understand their care plan in the context of that environment.2
Building on prior studies, a team at the Cleveland Clinic Health System (CCHS) implemented a home visit program, called High Risk Transitions in Care (HRTIC), with the goal of reducing 30-day hospital readmissions for discharged patients at high risk for readmission.2 The program aimed to leverage the scope of practice of advanced practice registered nurses (APRNs) along with acute care skills offered by paramedics.
The innovation evolved in two phases. In the first phase, the CCHS team experimented with a model that offered three home visits provided by either APRNs or paramedics in the first four weeks following discharge. After five months in Phase 1, the CCHS team found no significant difference in readmission rates for the participating population when compared with a matched cohort.2 In Phase 2, CCHS adapted the innovation by delivering a total of four home visits to referred patients within 30 days of discharge. APRNs provided the first post-discharge home visit, and paramedics, in coordination with the APRN and the patient’s larger care team, often provided subsequent home visits.2 After six months, the home visit program was associated with about 10% fewer readmissions when compared with a matched cohort.2
Beyond the additional home visit, the CCHS team believes that a key reason that the Phase 2 results were encouraging was that the patients received care from both types of providers, receiving both the APRNs’ skill as independent practitioners to diagnose and treat illnesses and the paramedics’ rapid response capabilities and acute care experience.
To evaluate the longer-term effects of the HRTIC program, the CCHS team compared readmission rates 60 and 90 days after hospital discharge for the Phase 2 group with those of a matched comparison group. Readmission rates did not differ between the two groups, indicating a potential need to extend visits beyond four weeks to sustain outcomes.2
Factors that contribute to sustaining a successful program, according to the CCHS team, include a centralized referral system that utilizes an administrative team to schedule the home visits. The team said the innovation requires flexible criteria for identifying high-risk patients in case the criteria need to be adjusted because the program does not have the capacity to serve the existing volume of referred patients. In the future, the CCHS team would like to explore the reasons patients decline home visit programs and strategies for increasing patient participation.
Lane S, Gross M, Arzola C, et al. Can J Anaesth. Epub 2022 Mar 22.
This Spotlight Case describes an older man incidentally diagnosed with prostate cancer, with metastases to the bone. He was seen in clinic one month after that discharge, without family present, and scheduled for outpatient biopsy. He showed up to the biopsy without adequate preparation and so it was rescheduled. He did not show up to the following four oncology appointments.